Marmara University Medical Faculty, Department of Pediatrics, Division of Pediatric Infectious Diseases, T.C. Sağlik Bakanlığı Marmara Üniversitesi Hastanesi, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi, Üst-Kaynarca, Pendik, Istanbul, Turkey.
Expert Rev Mol Diagn. 2011 Jul;11(6):643-60. doi: 10.1586/erm.11.46.
The diagnosis and treatment of TB infection is one of the public health priorities. Until recently, diagnosis of TB infection has been based on the tuberculin skin test (TST). However, this is neither 100% sensitive nor specific for the diagnosis of TB infection owing to its many drawbacks. More recently, T-cell-based IFN-γ release assays (IGRAs) have been developed. In this article, we review the clinical performance of one of the IGRAs, T-SPOT.TB assay, for the diagnosis of TB infection in adults and children. We discuss the principle of the assay, its utility in active TB diseases, latent TB infection and the performance of the test in specialized subgroups of patients, such as immunocompromised individuals. When compared with the TST, the T-SPOT.TB assay has better specificity in bacillus Calmette-Guérin-vaccinated individuals, and data suggest that T-SPOT.TB may be more sensitive than the TST. Data in groups at high risk of progression to disease support the idea that T-SPOT.TB performs better than the TST. In addition, application of T-SPOT.TB by using bodily fluids such as cerebrospinal fluid, bronchoalveolar lavage fluid and pleural fluid may offer new diagnostic approaches in extrapulmonary TB disease. Although IGRAs cannot distinguish active TB disease from latent TB infection, these assays perform better than the TST for the detection of TB infection.
结核病感染的诊断和治疗是公共卫生重点之一。直到最近，结核病感染的诊断一直基于结核菌素皮肤试验（TST）。然而，由于其许多缺点，TST 既不是诊断结核病感染的 100％敏感也不是特异性的。最近，基于 T 细胞的 IFN-γ 释放测定（IGRAs）已经开发出来。本文综述了其中一种 IGRAs，T-SPOT.TB 检测，在成人和儿童结核病感染诊断中的临床性能。我们讨论了该检测的原理，其在活动性结核病、潜伏性结核病感染中的应用，以及在免疫功能低下等特定亚组患者中的检测性能。与 TST 相比，T-SPOT.TB 检测在卡介苗接种者中的特异性更好，并且数据表明 T-SPOT.TB 可能比 TST 更敏感。在有进展为疾病风险较高的人群中的数据支持 T-SPOT.TB 比 TST 表现更好的观点。此外，应用 T-SPOT.TB 检测体液，如脑脊液、支气管肺泡灌洗液和胸腔积液，可能为肺外结核病提供新的诊断方法。虽然 IGRAs 不能区分活动性结核病和潜伏性结核病感染，但这些检测在检测结核病感染方面比 TST 更有效。
